Substance use disorder is a treatable medical condition involving continued use of alcohol, opioids or other substances despite harm. Outpatient treatment combines FDA-approved medication (naltrexone, acamprosate or disulfiram for alcohol; buprenorphine or naltrexone for opioids), therapy, and treatment of co-occurring depression, anxiety or PTSD. Medication for opioid use disorder cuts the risk of overdose death roughly in half.
Stedfast Psychiatry provides outpatient addiction psychiatry: evaluation, FDA-approved medications for alcohol and opioid use disorders, treatment of co-occurring mental health conditions, and coordination with detox, residential, intensive outpatient and recovery programs. We treat substance use as a health problem, without judgment, and we meet patients at whatever stage of change they are in.
Symptoms of substance use disorder
- Using more or for longer than intended
- Repeated unsuccessful attempts to cut down or stop
- Craving or a strong urge to use
- Spending a great deal of time obtaining, using or recovering
- Failing to meet obligations at work, school or home
- Continuing to use despite relationship, health or legal problems
- Giving up activities you used to enjoy
- Needing more to get the same effect (tolerance)
- Withdrawal symptoms when stopping (shakiness, sweating, anxiety, nausea, insomnia)
- Using in physically dangerous situations such as driving
Causes and risk factors
Addiction risk is about half genetic, with inherited differences in how the brain responds to substances and in impulsivity and stress reactivity. Early exposure matters: starting alcohol or drugs in adolescence greatly raises the risk of later addiction. Trauma, chronic stress, untreated mental illness and chronic pain often drive use as self-medication. Repeated use then rewires the brain: dopamine signaling in the reward system shifts so that the substance becomes necessary to feel normal, the prefrontal cortex's control over impulses weakens, and stress systems become sensitized so that withdrawal and cues trigger intense craving. These changes persist well into recovery, which is why relapse is common early and why medication that stabilizes these systems is so effective.
In 2023, 48.5 million Americans aged 12 and older (16.7 percent) had a substance use disorder in the past year, including 28.9 million with alcohol use disorder.
Source: SAMHSA, National Survey on Drug Use and Health 2023
Only about one in four people with a substance use disorder received any treatment in the past year.
Source: SAMHSA, National Survey on Drug Use and Health
Buprenorphine and methadone treatment reduce the risk of death from opioid overdose by roughly 50 percent.
Source: National Institute on Drug Abuse; Sordo et al., BMJ 2017
About half of people with a substance use disorder will have a co-occurring mental illness at some point, and vice versa.
Source: National Institute on Drug Abuse
How we diagnose it at Stedfast Psychiatry
Our evaluation covers each substance used, the amount, frequency, duration and route, prior withdrawal episodes including seizures or delirium tremens, overdoses, prior treatment, and current pattern. We use standardized tools including the AUDIT for alcohol and the DAST for drugs, and we assess DSM-5-TR criteria to rate severity. We screen carefully for co-occurring depression, anxiety, PTSD, ADHD, bipolar disorder and psychosis, distinguishing substance-induced symptoms from independent conditions by their timing relative to use. Labs include liver function, a complete blood count, hepatitis B and C and HIV screening where indicated, and a urine drug screen as a clinical tool rather than a test to pass. We assess whether medically supervised withdrawal is needed, since alcohol and benzodiazepine withdrawal can be life-threatening, and whether outpatient care is the right level.
Treatment options
Medication management
For alcohol use disorder, naltrexone (daily oral or monthly Vivitrol injection) reduces craving and the reward from drinking and is first-line; acamprosate supports abstinence after withdrawal, particularly with liver disease; disulfiram creates an aversive reaction to alcohol for motivated patients with supervision; and topiramate and gabapentin are evidence-based off-label options. For opioid use disorder, buprenorphine (Suboxone, Subutex, and the monthly Sublocade or Brixadi injections) is prescribed in our offices and by telehealth, started after mild withdrawal has begun, and continued long term; it cuts overdose deaths by about half. Extended-release naltrexone is an alternative for patients who have fully detoxified. We prescribe naloxone to every patient with opioid use disorder. For tobacco, varenicline, bupropion and nicotine replacement are effective, and Deep TMS was FDA-cleared for smoking cessation in 2020. For stimulant and cannabis use disorders, no FDA-approved medication exists, and we use behavioral treatment plus medication for the co-occurring conditions driving use. We treat depression, anxiety, PTSD and ADHD concurrently, choosing medications with low misuse potential where relevant.
Psychotherapy and recovery support
Motivational interviewing helps resolve ambivalence about change. Cognitive behavioral therapy for substance use teaches you to identify triggers, manage craving and handle high-risk situations. Contingency management, which rewards verified abstinence, has the best evidence for stimulant use disorder. Trauma-focused therapy is essential when PTSD drives use. We refer to intensive outpatient programs, partial hospitalization and residential treatment when weekly care is not enough, and we support engagement with mutual-help groups including AA, NA, SMART Recovery and Refuge Recovery. Family members benefit from Al-Anon and the CRAFT approach, and we involve them when the patient agrees.
What to expect
The first visit is a 60-minute evaluation, in person or by video. We assess safety, including withdrawal risk, and agree on a plan that may include starting medication the same day, a referral for medically supervised withdrawal, therapy and recovery support. Early follow-ups are weekly or every two weeks, then monthly once stable; buprenorphine visits follow the required monitoring schedule. Telehealth visits are available across Florida and South Carolina for follow-up and, within current federal and state rules, for buprenorphine care. Your treatment is confidential under federal law (42 CFR Part 2), with stronger protections than most medical records.
When to seek help
Seek help if you have tried to cut down and could not, if use is affecting your health, work or relationships, or if someone you trust is worried. Do not stop alcohol or benzodiazepines abruptly on your own after heavy daily use; withdrawal can cause seizures and requires medical supervision. If someone has overdosed, call 911, give naloxone if available, and stay with them; Florida and South Carolina Good Samaritan laws protect people who call for help. If you are having thoughts of suicide, call or text 988. The SAMHSA National Helpline (1-800-662-4357) is free, confidential and available 24 hours a day.
Substances we treat
Alcohol use disorder is the most common and the most medically dangerous in withdrawal. Opioid use disorder, involving prescription painkillers, heroin or fentanyl, carries the highest overdose risk, and fentanyl now contaminates much of the illicit drug supply, including counterfeit pills and stimulants. Stimulant use disorder (methamphetamine, cocaine, misused prescription stimulants) has no approved medication but responds to contingency management and treatment of underlying ADHD or depression. Cannabis use disorder affects about three in ten regular users, and high-potency products raise the risk of psychosis in young people. Sedative use disorder involving benzodiazepines requires a slow, supervised taper. Tobacco and nicotine vaping remain the leading preventable cause of death and we treat them as seriously as any other substance. Gambling disorder and other behavioral addictions are also within our scope.
Co-occurring disorders
Dual diagnosis is the rule, not the exception. Depression and anxiety are present in about half of people with substance use disorders; PTSD in a third or more, especially in veterans and survivors of violence; ADHD in a quarter; bipolar disorder and schizophrenia at elevated rates. Substances are often used to manage symptoms (alcohol for social anxiety or sleep, stimulants for untreated ADHD, opioids for pain and emotional numbing), and they then worsen the condition they were meant to relieve. Integrated treatment, in which one team treats both at the same time, has better outcomes than sequential or parallel care, and that is how we work.
Harm reduction and stages of change
Not everyone is ready to stop, and treatment starts wherever you are. Reducing use, switching to safer routes, carrying naloxone, testing for fentanyl, and never using alone all reduce harm while motivation builds. Naltrexone works for people who want to drink less rather than stop. We measure success by health, function and safety, not only by abstinence, and we do not discharge patients for relapse, which is part of the illness, not a failure of treatment.
Recovery over time
The first year of recovery carries the highest relapse risk, and the brain changes of addiction take months to years to settle. Medication, continued therapy, sleep, exercise, stable routines and a recovery community all lower risk. Chronic pain, insomnia and untreated mental illness are common relapse drivers and are treated directly. Family relationships rebuilt through programs like CRAFT and Al-Anon support both the patient and the people around them.
Prognosis
Substance use disorders are chronic, relapsing conditions comparable to diabetes or hypertension, and they are treated as successfully. Roughly three quarters of people who develop a substance use disorder eventually recover, and medication for alcohol and opioid use disorder substantially improves the odds and reduces death. The most reliable predictors of recovery are staying engaged in treatment, treating co-occurring conditions, and having support. Our job is to make treatment accessible enough to stay in.
Frequently asked questions
What is the difference between an addiction psychiatrist and a rehab program?
Addiction psychiatry is outpatient medical care: diagnosis, medication such as buprenorphine or naltrexone, and treatment of the depression, anxiety or trauma that drives use, delivered in regular office or video visits while you live your life. Rehab programs (residential, partial hospitalization, intensive outpatient) provide structured daily treatment for a defined period. Many patients use both, and we refer to and coordinate with programs when the intensity is needed. Psychiatric care continues after a program ends, which is when relapse risk is highest.
Is Suboxone just replacing one addiction with another?
No. Buprenorphine is a partial opioid agonist that stabilizes the brain's opioid system without producing the highs and crashes of misuse, and taking a prescribed medication that lets you work, parent and stay alive is treatment, not addiction. Patients on buprenorphine have about half the overdose death rate of those who are not, and better retention in treatment than with any other approach. Length of treatment is individualized, and many people stay on it for years with good reason.
What medication can help me stop drinking?
Naltrexone is first-line: it reduces craving and the pleasure of drinking, works whether your goal is abstinence or cutting down, and is available as a daily pill or a monthly injection (Vivitrol). Acamprosate helps maintain abstinence once you have stopped. Disulfiram causes a severe reaction if you drink and suits highly motivated patients with supervision. Gabapentin and topiramate are evidence-based alternatives. These medications are underused; fewer than one in ten people with alcohol use disorder receive one.
Can I get addiction treatment by telehealth?
Yes, for much of it. Evaluation, naltrexone, acamprosate and medications for co-occurring conditions can be managed by video across Florida and South Carolina. Buprenorphine can be prescribed by telehealth under current federal rules, which have changed several times; our staff will tell you what applies. Medically supervised withdrawal from alcohol or benzodiazepines requires in-person or inpatient care.
Is addiction treatment covered by insurance?
Yes. Federal parity law requires insurers to cover substance use treatment on the same terms as medical care, and we accept most major plans and Medicare. Visits are billed as psychiatric visits with your usual copay; our self-pay rate for a new evaluation is $185. Generic naltrexone, buprenorphine and acamprosate are inexpensive; Vivitrol and Sublocade require prior authorization, which we handle. Your records are protected under 42 CFR Part 2.
Will my depression or anxiety go away if I stop using?
Sometimes, and sometimes not. Substance-induced depression and anxiety usually improve within two to four weeks of stopping. Symptoms that persist beyond that, or that were present before use began, indicate an independent condition that needs its own treatment, and treating it reduces relapse. We do not make you wait months sober before treating depression, anxiety, PTSD or ADHD; we treat them together, choosing medications that are safe in recovery.
Can you treat ADHD in someone with a history of addiction?
Yes, carefully. Untreated ADHD roughly doubles the risk of substance use disorder, and treating it lowers relapse. We prefer non-stimulants (atomoxetine, viloxazine, guanfacine) or long-acting stimulants with low misuse potential, use a single prescriber and pharmacy, and monitor closely. Stimulants are generally deferred during active stimulant use disorder. The decision is individualized and made together.
Do you treat teenagers with substance use problems?
Yes. Adolescent substance use, especially cannabis, vaping and alcohol, often overlaps with ADHD, depression, anxiety and trauma, and treating those conditions is central to reducing use. Our child and adolescent providers evaluate teens, involve families, and coordinate with adolescent-specific programs when more structure is needed. Early intervention matters because the adolescent brain is especially vulnerable to developing addiction, and most adult substance use disorders begin before age 18.
Where to get treatment for substance use and addiction
Evaluation and treatment for substance use and addiction is available at every Stedfast Psychiatry office and by video across Florida and South Carolina.
Related conditions
If you are thinking about harming yourself, call or text 988 now, or go to the nearest emergency room. This page is educational and does not replace an evaluation. Clinical content reviewed by Dr. David Husted, board-certified psychiatrist.